[go: up one dir, main page]
More Web Proxy on the site http://driver.im/ Skip to main content
Springer Nature Link
Log in

Clinical validation of the two-point method for predicting vancomycin AUC based on peak and trough plasma concentrations

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background

Vancomycin area under the curve/minimum inhibitory concentration (AUC/MIC) has been proposed as a therapeutic drug monitoring (TDM) target to dose vancomycin. It is time-consuming to estimate AUCs using traditional methods. A two-point trough-peak method is more straightforward for calculating the vancomycin AUC. However, the technique and the AUC/MIC target have not been validated in Chinese patients.

Aim

To compare the clinical outcomes of vancomycin therapy in Chinese older adults (aged > 60 years) between the trough-only and the two-point peak-trough AUC TDM approaches.

Method

The patients were divided into study and control groups according to TDM approaches. A trough-based TDM was used in the control group (target trough level 15–20 mg/L). Stanford University has provided a method to predict vancomycin AUC using peak-valley concentration alone (two-point method). A two-point trough-peak TDM approach was employed in the study group (target AUC/MIC ≥ 400). The effect of vancomycin was evaluated in terms of clinical findings, laboratory values, and bacteriologic responses. The effects of treatment and kidney functions were compared between the two groups.

Results

A total of 389 patients met the study inclusion criteria, and 189 were excluded based on the exclusion criteria. Of the 200 patients, 80 received the two-point TDM approach (the study group), and 120 were monitored using the trough-based approach (the control group). The average age was 69.8 ± 7.1 years. Staphylococcus aureus (34%) was the most common Gram-positive bacteria. No vancomycin-related nephrotoxicity was observed in either group. The percentages of patients with an excellent response to vancomycin therapy were significantly higher in the study group than in the control group, 90% (72/80) versus 73.3% (88/120), P = 0.0039.

Conclusion

The two-point peak-trough method is practical for obtaining vancomycin AUC. The AUC/MIC ≥ 400 target demonstrates treatment effectiveness and safety in older Chinese patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
£29.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stogios PJ, Savchenko A. Molecular mechanisms of vancomycin resistance. Protein Sci. 2020;29(3):654–69.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Oda K, Jono H, Nosaka K, et al. Reduced nephrotoxicity with vancomycin therapeutic drug monitoring guided by area under the concentration-time curve against a trough 15–20 μg/mL concentration. Int J Antimicrob Agents. 2020;56(4): 106109.

    Article  PubMed  CAS  Google Scholar 

  3. Drennan PG, Begg EJ, Gardiner SJ, et al. The dosing and monitoring of vancomycin: what is the best way forward? Int J Antimicrob Agents. 2019;53(4):401–7.

    Article  PubMed  CAS  Google Scholar 

  4. Kabbara WK, El-Khoury G, Chamas NR. Prospective evaluation of vancomycin therapeutic usage and trough levels monitoring. J Infect Dev Ctries. 2018;12(11):978–84.

    Article  PubMed  CAS  Google Scholar 

  5. Aljefri DM, Avedissian SN, Rhodes NJ, et al. Vancomycin area under the curve and acute kidney injury: a meta-analysis. Clin Infect Dis. 2019;69(11):1881–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Suchánková H, Lečbychová K, Strojil J, et al. Individualized dosing of vancomycin in geriatric patients. Epidemiol Mikrobiol Imunol. 2020;69(4):172–80.

    PubMed  Google Scholar 

  7. Barber KE, Bell AM, Stover KR, et al. Intravenous vancomycin dosing in the elderly: a focus on clinical issues and practical application. Drugs Aging. 2016;33(12):845–54.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Finch NA, Zasowski EJ, Murray KP, et al. A quasi-experiment to study the impact of vancomycin area under the concentration-time curve-guided dosing on vancomycin-associated nephrotoxicity. Antimicrob Agents Chemother. 2017;61(12):e01293-e1317.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lee BV, Fong G, Bolaris M, et al. Cost-benefit analysis comparing trough, two-level AUC and Bayesian AUC dosing for vancomycin. Clin Microbiol Infect. 2021;27(9):1346.e1-1346.e7.

    Article  PubMed  CAS  Google Scholar 

  10. Meng L, Wong T, Huang S, et al. Conversion from vancomycin trough concentration-guided dosing to area under the curve-guided dosing using two sample measurements in adults: implementation at an Academic Medical Center. Pharmacotherapy. 2019;39(4):433–42.

    Article  PubMed  CAS  Google Scholar 

  11. Álvarez R, López Cortés LE, Molina J, et al. Optimizing the clinical use of vancomycin. Antimicrob Agents Chemother. 2016;60(5):2601–9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Drennan PG, Begg EJ, Gardiner SJ, et al. The dosing and monitoring of vancomycin: what is the best way forward? Int J Antimicrob Agents. 2019;53(4):401–7.

    Article  PubMed  CAS  Google Scholar 

  13. Al-Sulaiti FK, Nader AM, Saad MO, et al. Clinical and pharmacokinetic outcomes of peak-trough-based versus trough-based vancomycin therapeutic drug monitoring approaches: a pragmatic randomized controlled trial. Eur J Drug Metab Pharmacokinet. 2019;44(5):639–52.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Shah DN, Bhatt NS, Welch JK, et al. Defining acute renal dysfunction as a criterion for the severity of Clostridium difficile infection in patients with community-onset vs hospital-onset infection. J Hosp Infect. 2013;83(4):294–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Ahmed MO, Baptiste KE. Vancomycin-resistant enterococci: a review of antimicrobial resistance mechanisms and perspectives of human and animal health. Microb Drug Resist. 2018;24(5):590–606.

    Article  PubMed  CAS  Google Scholar 

  16. Lodise TP, Drusano G. Vancomycin area under the curve-guided dosing and monitoring for adult and pediatric patients with suspected or documented serious methicillin-resistant Staphylococcus Aureus infections: putting the safety of our patients first. Clin Infect Dis. 2021;72(9):1497–501.

    Article  PubMed  CAS  Google Scholar 

  17. Cusumano JA, Klinker KP, Huttner A, et al. Towards precision medicine: Therapeutic drug monitoring-guided dosing of vancomycin and β-lactam antibiotics to maximize effectiveness and minimize toxicity. Am J Health Syst Pharm. 2020;77(14):1104–12.

    Article  PubMed  Google Scholar 

  18. Rybak M, Lomaestro B, Rotschafer JC, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm. 2009;66(1):82–98.

    Article  PubMed  CAS  Google Scholar 

  19. Rybak MJ, Le J, Lodise TP, et al. Therapeutic monitoring of Vancomycin for serious methicillin-resistant Staphylococcus Aureus infections: a revised consensus guideline and review by the American society of health-system pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis. 2020;71(6):1361–4.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

None.

Funding

This study was supported by the Natural Science Foundation of Fujian Province, China (Grant No. 2020J011094).

Author information

Author notes

  1. Liming Wang and Xiaolan Lin have contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Pharmacy, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No. 134 Dongjie Road, Fuzhou, 350001, Fujian, China

    Ling Wang, Hong Ye, Yuxing Lin & Junshan Ruan

  2. Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China

    Xiaolan Lin

  3. Department of Intensive Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No. 134 Dongjie Road, Fuzhou, 350001, Fujian, China

    Liming Wang & Songqing Shi

Authors
  1. Liming Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaolan Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ling Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hong Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuxing Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Junshan Ruan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Songqing Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Junshan Ruan or Songqing Shi.

Ethics declarations

Conflicts of interest

Authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, L., Lin, X., Wang, L. et al. Clinical validation of the two-point method for predicting vancomycin AUC based on peak and trough plasma concentrations. Int J Clin Pharm 44, 1325–1331 (2022). https://doi.org/10.1007/s11096-022-01474-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-022-01474-9

Keywords

Search

Navigation